Main points in this case

The existence of rapid cycling bipolar affective disorder and the use of Zyprexa (olanzapine).

The importance of research into bipolar affective disorder.

Simon

I am 30 years old and used to work as a professional musician. I have not been able to work since I was diagnosed with rapid cycling bipolar affective disorder three years ago.

I have spent a lot of time in hospital and my doctors say that my illness is particularly difficult to treat. They have tried all sorts of combinations of drugs.

Although I wasn't diagnosed until I was 27, I know I've had bipolar disorder since at least the age of 20. When I was studying music at university I had several periods that I now realise were episodes of depression and mania.

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I coped with the depression by drinking alcohol. During the manic phases I would be really productive, practise my clarinet all day and night, and devise really ambitious plans for concerts and other major events at uni.

None of these plans ever worked out, and now I feel embarrassed because they were so unrealistic. My friends and university tutors would often express concern about me, but I was too frightened to see a doctor. I didn't even want to think of the possibility of being mentally ill.

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I finished my degree, but I spent the following twelve months leading a very chaotic life and got into trouble with the police several times. I eventually saw a psychiatrist and was told I had bipolar affective disorder.

Could the delay in me seeking medical attention have worsened the course of my illness?

Doctor

Prompt medical diagnosis and treatment is important with any illness and mental illnesses are no exception. As you have experienced, the problems people can face during periods of mental illness often cause disruption and chaos, which affects relationships, jobs and finances.

Seeking medical help as soon as possible can help to reduce the impact of these difficulties, and appropriate treatment also reduces the likelihood of encountering similar problems in the future. This is particularly important in a condition like bipolar affective disorder, which is a lifelong illness characterised by periods of mania and depression though for long periods of time you will be completely well.

Many people find it difficult to face up to a diagnosis of mental illness, but there is a lot of support available from mental health care professionals to help people understand and live with their illness.

There has been a lot of interest in the impact of "delayed" diagnosis and treatment of mental illness in recent years When we use the word delayed we mean a situation when no-one realised what the problem is until some time has gone by.. There is some evidence to suggest that identifying and treating schizophrenia as quickly as possible after it begins to affect a person can reduce the severity and impact of the illness.

There is less research in this area for bipolar affective disorder, but some recent evidence does indicate that prompt diagnosis and treatment can reduce the impact of the disease and improve quality of life.

Doctor

Rapid cycling bipolar affective disorder can sometimes be very difficult to treat. It means you have four or more periods of mania or depression in a year.

Mood stabilising drugs can be used alone or in combination to treat the illness and reduce the number of depressive and manic episodes.

If you are on medication and experience further episodes of illness, it may be necessary to change the medication by increasing the dose or by adding a different drug or drugs.

Zyprexa is what we call
an "atypical" antipsychotic drug. It is known to be effective in treating
mania, particularly in the acute phase of the illness when people are very unwell.

It has sedative properties and as a consequence relieves symptoms such as over-activity and disturbed sleep. It's also believed the medicine has a mood stabilising action, which may treat the symptoms of mania independent of this sedative effect.

There is also some evidence to support the idea that olanzapine may offer some protection against subsequently developing depression following a manic episode, again through its mood stabilising action.

Simon

I try to keep up-to-date with research developments in bipolar affective disorder, especially for new treatments. But compared with illnesses like schizophrenia, there doesn't seem to be the same amount of interest. Why is this?

Doctor

Your view about research and funding is entirely correct. For too long mental health problems have been starved of resources in comparison to other 'physical' illnesses.

Bipolar affective disorder is a serious and sometimes devastating mental illness, which has also been relatively under-researched compared to schizophrenia and depression.

However, there are a number of funding bodies around the world who are encouraging good research into this disorder. This is encouraging.

The medical literature frequently reports the results of newly investigated treatments for this bipolar, but progress is slow.

We can be optimistic that as this research continues, the treatments available will improve.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.

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